Tel: (800) 467-9736 | Fax: (732) 549-7060 | 100 Wood Ave. South, Suite 111, Iselin, NJ 08830 | Email: train@sysoft.com
Course Registration Form: Self-Paced Program (To register please fax/mail this form with payment)

Name: _____________________________________ Company ______________________________Title __________________

Address : _________________________________________________________________________________________________

___________________________________________________________________________________________________________

Phone : ____________________________ Fax : ____________________________ E-Mail :_____________________________

Yes! I'd like to register for the self-paced program:
Corporate Webmaster, e-Commerce - II (Sysoft 3200)

Start Date: ____________ (Keep Blank if not sure)

q $395

 Corporate Webmaster, e-Commerce - I (Sysoft 3000)

Start Date: ____________ (Keep Blank if not sure)

q $395
Productive Web Development, Multimedia & Wireless Application Protocol (Sysoft 1200)

Start Date: ____________ (Keep Blank if not sure)

q $395

 Web Application Development, Networking & Database (Sysoft 1000)

Start Date: ____________ (Keep Blank if not sure)

q $395
Database Administration for eHealth (Sysoft 8400)

Start Date: ____________ (Keep Blank if not sure)

q $395

 HIPAA Awareness Certification (Health Insurance Portability & Accountability Act) (Sysoft 6100)

Start Date: ____________ (Keep Blank if not sure)

q $195
Implementing HIPAA and eHealth - Health Care Information Systems (Certified eHealth Professional) (Sysoft 6110)

Start Date: ____________ (Keep Blank if not sure)

q $395

  
Course Package: Sysoft 1000, 3000, 1200, 3200, 6100, 6110, 8400
Package Price for all Courses    U.S. $995*
 

* A $25 Application and a $100 registration fee is due from all applicants. The $125 application fee is non-refundable and is not included in the tuition. Add applicable Shipping and handling charges.


Shipping and Handling (Please select one). If you do not select one then regular for domestic US or International charge will be added to your order.

$45 Regular Per course (allow 2 weeks)

$65 Overnight Per course

$80 International Per course

$95 Regular for the 5 course package (allow 2 weeks)

$150 Overnight for the 5 course package

$195 International for the 5 course package

Check Enclosed (Check # ______________________ )( U.S. $50 penalty for return checks )
    ( Make checks or International money order payable to "A1 Sysoft Center for Software Excellence." in U.S. Dollars drawn on a U.S. bank )

Purchase Order Number: _______________________

Credit Card Information: (Please check one)  

American Express

Visa

MC

Authorized Amount  _____________________________________

Card Number:____________________________________ Expiration: __________________

Credit Card Name if Different from Name Above: ____________________________________

SYSOFT® reserves the right to refuse a registration. Prices are subject to change. If for some reason, Sysoft cancels a course, liability is limited to the fee paid by the applicant. You have money back guarantee if you return the books and materials within two weeks or before the second mentor session, which ever is first. Please note, shipping and handling charges and the registration and application fees are not refundable. Every return requires Return Authorization from the assigned mentor. Refund will be made within 6 weeks from the date course materials are received at the Sysoft facility.

YOUR SIGNATURE IS REQUIRED TO COMPLETE THE REGISTRATION PROCESS

 

Your Signature: ________________________________________________________